I think elderly care has failed a lot of people. It is such an important thing but in some places it’s simply not good enough. There’s basically a disjointed approach to end-of-life care. A lot is good but it’s the last 20% or so where things could improve - it´s multifactorial really.
The out-of-hours service doesn’t work well enough. They transfer people to hospital in the last hours of their lives against our express wishes.
NHS 111 was piloted in our area and so far it just doesn´t work as well as when we had GP co-ops. A&E staff aren´t trained in dementia or elderly care.
Another factor is the district nursing service. We used to have properly-trained nurses. Now they are lower grade nurses who haven´t had training in whole life care.
We’re trying to improve things. We are now in discussions with our CCG to make end-of-life care more GP-focused. As a GP you know which care worker, which district nurse to talk to about a patient. It makes sense for things to go through the GP and to keep as much care as possible outside the acute sector.
There are finite resources so we have to make do with what we have got. It would be lovely to have more but the other solution as GPs is to make our care more patient-centered, to improve our communications and join all the resources up.
Dr Peter Goodall is a GP in Southampton
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